Sleeve gastrectomy may weaken bones in youths

Adolescents and young adults who undergo vertical sleeve gastrectomy (VSG) experiences progressive changes in bone health over 2 years and are prone to skeletal fragility, suggests a study.

Sixty-six patients aged 13‒24 years with moderate-to-severe obesity who met the criteria for VSG were included in the observational 2-year study at a tertiary care centre. They underwent either VSG (n=30) or nonsurgical management (n=36; control) based on the decision of patient and clinical team.

The researchers then measured the following outcomes: dual-energy x-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HRpQCT) measures of bone mineral density (BMD), geometry, and microarchitecture.

Patients in the VSG arm achieved 25.3-percent weight loss at 2 years (p<0.001), while those in the control arm gained 4.0 percent (p=0.026).

Total hip BMD decreased by 8.5 percent with VSG relative to a gain of 0.1 percent with nonsurgical management (p<0.001), with similar findings at the femoral neck (p<0.001). In addition, total volumetric BMD (vBMD) decreased at the distal radius and tibia in VSG patients (p<0.001), which was driven by trabecular vBMD loss (p<0.001).

No between-group difference in changes in cortical vBMD occurred at 2 years, but cortical porosity decreased after VSG both at the radius (p=0.048) and tibia (p<0.001). On the other hand, the control group showed increased cortical thickness, but the VSG group did not (p=0.022 and p=0.002 for between-group comparisons at the radius and tibia, respectively).

“Following VSG, estimated failure load decreased at the radius and did not demonstrate the physiologic increases at the tibia observed in controls,” the researchers said.

VSG is a common intervention to achieve weight loss and improve metabolic health in adolescents and young adults with obesity, according to the researchers.